with a male colleague who could offer him an adolescent group to help with his social isolation. He agreed.
The First Session
Anne was scheduled for her first session with me later that week. When she came in, she informed me, “I am willing to talk about anything that would help Justin. I might need guidance along the way, but as I told you, I do not want to dig deeply into my own past.” Her guard was up, posture rigid, movements controlled, and there was a measured quality to her speech. Anne shared Justin’s developmental history.
Justin had been an easy delivery, arriving the week of his due date. A healthy, gregarious baby, he had worshipped his older brother from the time he could toddle around after him. Most of the time, they had played well together. He’d also had a little group of friends who would come over periodically for play dates, and he always had a couple of good buddies. Around Justin’s seventh birthday, he began to develop a passion for reading autobiographies and history books. Anne had taken great pleasure in reading Justin’s compositions, as had his teachers. According to Anne, Justin had always been a good boy without any behavioral worries, until he began withdrawing in high school.
Through several conversations, we slowly established a rapport, but Anne remained tight-lipped when it came to discussing her own past. I waited cautiously for an opportunity to dig deeper. About a month into our sessions, Anne said, “I’ve been noticing how much Justin isolates himself from the outside world and how it’s taking a toll. It makes me realize that I do the same. My whole life revolves around my family and work. I never speak with anyone about personal matters. I was taught that family loyalty and privacy were to be upheld at all costs. Even Stephen doesn’t know details of my whole story. I don’t think the secrecy has served me well over the years, but it is all that I ever knew. Justin gets that from me.”
She looked at me directly, as though she had just had some sort of profound revelation, and then rapidly continued: “There’s something else you need to know. My sister Beth committed suicide about thirty years ago. She hanged herself in the basement. By the time she was found, she was gone. I’m terrified that Justin might be entertaining such thoughts. I’ve never spoken to anyone but Stephen about Beth’s death, but I thought you should know. It was all too hideous, and besides, my mother insisted that we never speak about Beth with outsiders.”
The Dark Side of Stress
There it was! Anne had entered therapy, reluctantly, to help her son. During our first few sessions, she was able to access the tip of her own personal iceberg of pain—and the stress of keeping it in check—that had permeated every aspect of her life and her relationships.
Stress of any sort is so commonplace that it often can feel normal, even in the midst of abnormal or tragic circumstances, such as the suicide of a sibling. It becomes the only way of life we know. This is especially true as we move from a childhood trauma into a busy adult life, juggling family and work responsibilities. As a young working mom, Anne had focused completely on creating a good life for her family. But as her children grew, she found herself feeling more afraid and withdrawn. The longer she isolated herself from others and kept her past a secret, the more scared and stressed she became. Although Anne believed that her son was the one at risk of harming himself, it is not unusual to see in others that which we find difficult to recognize and acknowledge in ourselves. I wondered whether her concern was a projection of her own self-destructive choices.
When we are constantly stressed and operating in “emergency mode”—as Anne was when she vigilantly guarded her family history and the secret of her sister’s suicide—the mind and body pay a steep price. The ability to think clearly and to feel our best can become seriously impaired. The scientist Hans Selye coined the term stress in 1936. He defined it as the “nonspecific response of the body to any demand for change.” It matters not whether the demand is real or perceived. As he explained in Stress without Distress in 1974, “It is not stress that kills us, it is our reaction to it.”3
Misperceived or mismanaged stress can make us unhappy and sick with physical symptoms such as sleep disturbances, fatigue, pain, high blood pressure, heart palpitations, weight gain or loss, and digestive problems. Some common psychological manifestations of stress include anxiety, irritability, depression, memory lapses, poor concentration, phobias, and feeling out of control.
Managing stress and trauma often begins with the willingness to self-disclose, or share, our personal story. This is the first step toward making sense of our complicated emotional realities. Like Anne, sometimes patients do not come right out and tell me what the problem is. Instead, they talk about someone or something else to stay away from the pain of their own old wounds. It takes time to trust, to find a safe haven in which we can reveal our stories and gain a deeper understanding of the disappointments and hurts we have experienced.
After years of silence, in the name of helping her son, Anne decided to let someone other than her husband know that there had been a family suicide. Immediately after sharing that information, Anne straightened up and said in a restrained cadence, “I’ve told you the important information, now I just want to make sure that my boy is safe.” As rapidly as Anne had opened up, she shut down any further discussion.
Reluctant to let her shut down, I offered, “Your loyalty to your family and the secrecy you maintained may have protected you from the pain over the years, but these days it seems to be interfering with getting you the help you need. You might find sharing your story to be both cathartic and instructive. You and Stephen have been good parents, and despite Justin having some issues now, he seems to be headed in the right direction. Maybe this is a good time for you to consider getting help for yourself and come to terms with some of the events from your past.”
Anne said she would think about this. Several days before our next scheduled meeting, she called me, sounding frantic. She had been hospitalized over the weekend for chest pain and shortness of breath. Other than slightly elevated blood pressure, Anne’s lab results did not reveal anything. She had been told that her symptoms were consistent with severe anxiety or a panic attack.
Anxiety and Depression
Anxiety and depression are the hallmark feelings that bring people into therapy. They often mask deeper emotions that we wish to avoid or dare not feel, such as anger, shame, fear, or guilt. Depression occurs when we suppress and become numb to our feelings, whereas anxiety occurs when we take flight from our feelings or enter a heightened state of “fight-or-flight” arousal. Either way, we avoid authentic feelings that unconsciously seem to be more than we can tolerate. When we allow ourselves to observe, explore, experience, and finally resolve these feelings, only then are we liberated to move forward in our lives in a healthier way.
Anne arrived at my office later that day, hands trembling as she handed me her hospital report: “I felt like I was having a heart attack. I just can’t bear the thought of dying and leaving Stephen and the kids.” She huddled on my couch, wrapped her arms around her thin body, and waited for my response.
“Thankfully, that is not what’s going on,” I reassured her, while scanning her medical record. “Your report indicates high blood pressure, which can be managed through medication and making some lifestyle changes. For example, learning some breathing and meditation techniques and getting more exercise will help considerably. I would be happy to show you some relaxation skills right now that you can learn quickly. Other than that, you seem to be in good health. Panic attacks are terrifying, but they are not life-threatening.”
As I assured Anne, there are well-researched and effective strategies that can be incorporated into everyday life to protect us against the deleterious effects of panic, anxiety, and garden-variety stress. These methods also help quiet the mind so we can savor more of life’s moment-to-moment experiences. I wanted to teach Anne some simple yet powerful techniques that she could readily incorporate into her
